A review of the risk factors associated with juvenile-onset recurrent respiratory papillomatosis:genetic,immune and clinical aspects

Background Juvenile-onset recurrent respiratory papillomatosis(JoRRP)is one of the most common benign lesions of hyperplastic respiratory epithelial tissue in children and is predominantly caused by human papillomaviruses(HPVs)6 and 11.The clinical course of the disease is variable,and some patients even develop a malignancy.The purpose of this review was to summarize the related factors affecting the disease course in patients with JoRRP.Data sources We used databases,including PubMed and Google Scholar,to search for publications on factors associated with the genetic,immune,and clinical aspects of JoRRP.The most relevant articles to the scope of this review were chosen for analysis.Results Mother-to-child transmission is the most important mode of disease transmission;other factors,such as immune condition or genetic susceptibility,may be important determinants of JoRRP occurrence.Genetically,the presence of DRBI*0301 and HFV 6/11 E6/E7 is associated with a more severe disease.Immunewise,patients have an enhanced T helper 2-like response.In addition,regulatory T cells are enriched in tumors and may become one of the effective prognostic indicators.For clinical characteristics,patients infected with HPV-11 have more aggressive disease.However,compared with HPV type,age at first onset is a more important factor related to the aggressiveness of JoRRP.Furthermore,socioeconomic status may also affect the course.Conclusions Genetic,immune,and some clinical factors have been noted to play an important role in the course of JoRRP.Exploring definite influencing factors will be an important direction of research in the future.

Risk factors of juvenile onset recurrent respiratory papillomatosis in the lower respiratory tract

Background Juvenile onset recurrent respiratory papillomatosis （JORRP） is a relatively rare disease. It affects the larynx in most cases. Because reports on JORRP to the lower respiratory tract （LRT） are few, we investigated clinical features of patients with a history of JORRP to analyze the risk factors of this disease. Methods Data from 208 JORRP patients admitted to Beijing Tongren Hospital from January 2008 to December 2010 were reviewed. Gender, age at onset of symptoms, age at first surgery, duration of symptoms before the first surgical procedure, the number of surgical procedures, mean interval between surgical interventions, and the number of tracheotomies in patients with and without LRT spread of JORRP were analyzed. The data from patients with and without tracheotomy were recorded and compared. Two cases of primary tracheal papillomatosis were reviewed. Results Papillomas extension down to the LRT was observed in 46 children （22.1%）. Patients with LRT papillomatosis had a shorter time from the onset of the symptoms until the first surgery, required significantly more surgical procedures, and had a shorter mean surgical interval. Tracheotomy was performed in 13/162 （8.0%） children with laryngeal papillomatosis vs. 36/46 （78.3%） children with LRT papillomatosis. After tracheotomy, 36/49 （73.5%） children developed LRT papillomatosis and 10/157 （6.4%） children who did not have a tracheotomy developed LRT papillomatosis. Patients with tracheotomy required a significantly higher number of surgical procedures. The younger the patient had a tracheotomy, the longer the duration of cannulation was. Conclusions JORRP patients with LRT spread are prone to develop more aggressive disease. Tracheotomy resulted in a significant increase of LRT involvement.

Clinical Analysis of Hoarseness in Children as Seen in Otorhinolaryngology Department of a Tertiary Health Institution in North-West, Nigeria

Normal phonation is produced in the larynx by the blast of pulmonic air stream that vibrates the vocal cords. Hoarseness reflects changes in the structure or function of the vocal cords. Objective: This is to describe the clinical profile of hoarseness in children and aetiological factors in a tertiary health institution. Methodology: This is a retrospective eight-year (2006-2013) study of clinical records of patients with hoarseness as their main symptom seen in the ENT department of the Usmanu Danfodiyo University Teaching Hospital Sokoto. Results: Fifty-two children with hoarseness were studied. Thirty three (63.5%) were males, while 19 (36.5) were female with a male: female ratio of 1.7:1. The age range was 1 - 13 years with a mean age of 5.1 years. Age group 4 - 7 years (38.5%) were observed to be more affected with duration of hoarseness ranging from 1 day to 5 years. RRP 23 (44.2%) was the most common aetiology of hoarseness followed by foreign body 15 (28.8%) and Acute Laryngeal infections 9 (17.3%). Tracheostomy was done in 29 (55.8%) of patients. Two patients died post operatively due to improper tracheostomy tube care in the ward. Conclusion: With delayed presentation and its attendant grave sequelae, it has become imperative that persistent hoarseness in children lasting more than three weeks should be endoscopically evaluated by an otorhinolaryngologist.